ANASTOMOSIS DEVICE AND RELATED METHODS
An anastomosis device that includes a distal end portion is provided. The distal end portion of the catheter can include a stent-like drainage feature to prevent the formation of blood clots and to improve the flow of urine out of the catheter. The device can further include a balloon device having a thickened wall region to prevent puncturing or damage from the catheter tines.
The present application claims the benefit of U.S. Provisional Application No. 61/423,487 filed Dec. 15, 2010, and entitled “ANASTOMOSIS DEVICE AND RELATED METHODS” and U.S. Provisional Application No. 61/423,746 filed Dec. 16, 2010 and entitled “ANASTOMOSIS DEVICE AND RELATED METHODS”, both of which are incorporated herein in their entirety by reference.
FIELD OF THE INVENTIONThe present application generally relates to anastomosis devices for use in reconnecting urological lumens. More specifically, the present application is directed to anastomosis devices and related methods of avoiding clotting and plugging of a drainage lumen during use of the anastomosis device in reconnecting severed urological lumens.
BACKGROUND OF THE INVENTIONThere exist a variety of urological procedures where a step of the procedure involves severing a biological lumen and/or removing tissue. One such urological procedure is a radical prostatectomy, wherein a surgeon removes all or most of a patient's prostate. Because the urethra travels through the prostate immediately before reaching the bladder, an upper part of the urethra is also removed in the surgery. Once the prostate is removed, the radical prostatectomy procedure leaves a severed urethral stump and a severed bladder neck. To restore proper urinary functions, the bladder and the urethra must be reconnected through connection of the severed urethral stump to the severed bladder neck.
On conventional method by which this reconnection is accomplished is through the use of sutures wherein a surgeon executes delicate suturing operations with tiny, fine needles. The use of sutures as part of the reconnection procedure can be a difficult and often technique-sensitive task. Many factors can make this task difficult, including the typically small amounts of tissue to work with during reconnection (at the urethral stump and at the bladder neck), proximal ureters at the bladder, and a proximal nerve bundle and sphincter at the urethral stump. All of these add up to a complicated and delicate suturing procedure that, if not performed properly, can result in complications such as leakage, difficulty in healing or failure to heal, incontinence, or even impotence. Specific problems include necrosis of the sutured tissues; stricture of the urethra so as to impedes the flow of fluid through it; and a urethra-bladder connection that is not fluid-tight. In addition, methods of suturing the urethra to the bladder allow for accidental or inadvertent piercing of the nearby neurovascular bundle, which can cause incontinence or impotence.
The use of an anastomosis device in a radical prostatectomy procedure allows a physician to complete the reconnection procedure without the need, and consequently, the potential problems associated with suturing.
SUMMARY OF THE INVENTIONThe present application is directed to an anastomosis device that includes a catheter body and tissue approximating structure. The tissue approximating structure can be used to cause or maintain contact between severed portions of tissue to allow or cause the severed tissue surfaces to heal together, instead of using sutures. The device may be used, for example, in performing procedures such as a vesico-urethral anastomosis in association with a radical prostatectomy, or with an end-to-end urethral anastomosis. Advantageously, the device, including the tissue approximating structure, can be left installed during the healing process to function to allow the tissue to heal while at the same time functioning to drain urine from the bladder.
Embodiments of anastomosis devices of the invention, in addition to the tissue approximating structure, can include features and structures that function to drain the bladder, e.g., through a drain lumen, while at the same time functioning as a tissue approximating structure that causes contact between severed tissue to allow the severed tissues to heal together. Methods of the invention can use such an anastomosis device, including both a draining function and a tissue approximating function, to accomplish healing of the anastomosis, without sutures, and draining of the bladder, with the single anastomosis device and preferably without removing or replacing the device during or after the procedure until healing is complete. The anastomosis device can be installed during or after a radical prostate removal procedure, and can remain installed with the bladder-draining function and the tissue-approximating function in effect until the anastomosis is completely healed and the severed tissue, e.g., bladder and urethra, are re-connected. Thus, an advantage associated with inventive methods and devices can be that the anastomosis device performs dual functions when installed during and following an anastomosis procedure, of draining the bladder and functioning as a tissue approximating structure, at the same time.
Also advantageously, inventive methods and devices avoid the need to use sutures to connect severed tissue such as a bladder neck and urethral stump. The ability to avoid sutures provides very significant advantages of avoiding the potential for damage to surrounding tissues and nerves that can be caused by installation of sutures using a needle. Such damage can include, for example, damage to ureters at the bladder or damage to the sphincter or nerves located in the perineal floor. Damage to any of these tissues has the potential to cause incontinence or impotency. Additionally, installing sutures is a difficult and technique-sensitive process that must be performed in a confined space and that would be avoided if possible based on other alternatives. Thus, the invention offers the very significant advantage of eliminating the need to use sutures to re-attach severed tissues, and the attendant potential damage to those sensitive proximal tissues and nerves and the possibility of incontinence or impotency.
The terms “tissue approximating” and simply “approximating” refer to a process of bringing or holding body tissues in contact for healing. Examples include: the process of bringing severed surfaces of a bladder neck and a urethral stump, or two opposing severed urethral tissues, into contact for healing; and the process of holding severed surfaces of a bladder neck and a urethral stump, or two opposing severed urethral tissues, together for healing.
An aspect of the device relates to an anastomosis device comprising a hollow, elongate, flexible catheter body having a proximal end and a distal end; an inflatable balloon at the distal end; a drainage lumen connected to the distal end; and tissue approximating structure on the catheter body on a proximal side of the balloon at a location to contact severed tissue during an anastomosis procedure.
Another aspect of the invention relates to a method of performing urethral anastomosis. The method comprises inserting a portion of an anastomosis device into the urethra, the anastomosis device comprising tissue approximating structure and a distal end comprising a balloon; inflating the balloon in the bladder; and using the tissue approximating structure to hold severed tissue together. Preferably, the device further comprises drainage apertures for draining a bladder and the method comprises draining a bladder.
Certain embodiments of the invention can include tissue approximating structure having one or more tines extending therefrom. The tines can be formed as sharp elongate, tubular straight or curved, or fine metal barbs that movably extend from the distal end of the catheter body at a location to facilitate contact and penetration of the urethral stump proximal tissue in the adjacent perineal floor, urethra, or bulbar urethra.
Still other embodiments can include one or more catheters configured to prevent the formation of blood clots and, thereby, improving the flow of urine out of the catheter. The catheter can include a stent-like or like drainage feature provided proximate the distal tip and catheter balloon. The drainage feature can be constructed similar to Urolume™, with a silicone insert molded at both ends of the feature for a soft tip to facilitate insertion and bonding to other components.
The drainage feature can be inserted in a compressed state and then actuated or elongated to lengthen the feature. This will take the tip from a solid tube state to a Nitinol wire state with expanded holes or gaps for drainage. Alternatively, the drainage feature can be inserted in the elongated state. By pulling or otherwise activating the feature (e.g., with expansion of bladder tines), the feature is pulled inward or shorter such that it generally bubbles or expands out in the middle. This will give the feature a bulged profile to provide expanded gaps to make it more difficult for blood clots to fully cover and plug the tip.
In various embodiments, the expandable balloon proximate or at the distal portion of the device can be molded with a base portion that is measurably thicker than the other portions of the balloon. This will assist in preventing puncturing or other breaches of the region of the balloon coming into contact with sharp devices, such as the device tines. The shape of the balloon can be defined to accommodate the thicker base.
Various embodiments of the catheter can include a removable or replaceable lumen to provide reestablishment and maintenance of the urine flow through the device in the event the original or previously provided catheter lumen becomes blocked or obstructed. A removable and replaceable lumen allows for correction of any blockage without disturbing the anastomotic site.
The above summary of the various representative embodiments of the invention is not intended to describe each illustrated embodiment or every implementation of the invention. Rather, the embodiments are chosen and described so that others skilled in the art can appreciate and understand the principles and practices of the invention. The figures in the detailed description that follow more particularly exemplify these embodiments.
The invention can be completely understood in consideration of the following detailed description of various embodiments of the invention in connection with the accompanying drawings, in which:
While the invention is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the invention to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention as defined by the appended claims.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTSReferring generally to
An anastomosis device of the invention can include a hollow, elongate, flexible catheter body having a proximal end and a distal end. An inflatable balloon can be located near the distal end, and an inflation lumen for inflating the balloon can extend to the balloon along the catheter body, e.g., along a portion or all of the catheter body from the proximal end to the balloon. During use, the balloon can rest against the neck of the bladder to prevent urine from entering the neck and to prevent urine from contacting the anastomosis site. Urine at the anastomosis site has the potential to cause difficulties in healing or to cause a stricture, among other deleterious effects. With the balloon blocking the bladder neck during use, urine will pool in the bladder and can be drained from the bladder, for example, using one or more draining apertures at the distal end of the anastomosis device connected to a drainage lumen. A drainage lumen can extend from one or more drainage apertures near the distal end, e.g., from apertures at the distal end to a location that is at or near the proximal end.
Overall, an anastomosis device can contain various lumens (e.g., for inflating a balloon, drainage, providing a fluid channel or conduit to the tines, for containing actuating mechanisms for tissue approximating structure, etc.) and actuating mechanisms running along at least a partial length of the catheter body. The mechanisms and lumens can be arranged in any useful adaptation, such as coaxially, side-by-side, or according to any other useful configuration. A lumen or a mechanism (e.g., actuating mechanism) that runs along at least a portion of the length of the catheter body may be diverted at the proximal end of the catheter body to a port that provides access to the lumen or mechanism during use. Further, the various devices, components, mechanisms, and methods disclosed in U.S. Patent Publication No. 2007/0219584 can be employed, alone or in combination, with the present invention and, therefore, the above-identified publication is incorporated herein by reference in its entirety.
Referring generally to
Referring again to
According to embodiments of the invention, the tissue approximating structure 118 of anastomosis device 100 can be used to place or hold a cut or severed tissue or tissue surface in place for healing, as well as to inject or provide drugs or cell mixtures into target tissue to facilitate healing and overall tissue health. Referring generally to
The tissue approximating structure 118 of the anastomosis device 100 can be a structure of the device that can be used to cause contact between severed tissues, such as severed urethral tissues, or such as severed tissue of the bladder or bladder neck with severed tissue of the urethral stump or perineal floor, or alternatively or additionally to hold severed tissue surfaces in contact with each other for healing. In addition to the tissue approximating structure 118 including the distalmost approximating structure 119a and the proximalmost approximating structure 119b, the tissue approximating structure 118 can include, for example, one or multiple inflation balloons 114 or balloon-like structures that can be placed against the inside of the bladder or underneath the perineal floor to bring the severed bladder neck tissue into contact with the severed tissue surface of the urethral stump. The distalmost approximating structure 119a and the proximalmost approximating structure 119b can include elongate structures such as needles or tines (solid or hollow), prods, probes, or the like, which may have a blunt or a sharp end and may selectively extend or protrude from an aperture in the catheter body 106 at a location where the structure can function as an approximating structure, e.g., at the distal end portion 110 of the anastomosis device 100 where the distalmost approximating structure 119a and the proximalmost approximating structure 119b structure will be near the bladder or perineal wall (when installed), or at a severed urethra below the perineal floor (when installed). The tissue approximating structure 118 does not require and can specifically exclude and avoid the use of conventional sutures.
An example of a useful tissue approximating structure 118 can be in the form of a sharp or blunt elongate structure (e.g., a sharp-ended needle or tine) that can be movably extended from an aperture proximate the distal end portion 110 of, or along a length of, the catheter body 106, to thereby contact and optionally penetrate into or through one or more of a tissue of the bladder, bladder neck, urethra, bulbar urethra, urethral stump, or perineal floor. These structures can serve to place opposing severed tissue surface into contact for healing, and preferably also to hold the tissues in contact with each other during the healing period. Certain embodiments of the invention can include sharp or blunt elongate tissue approximating structure 118 (e.g., a sharp-ended needle or tine) that can be movably extended from an aperture proximate the distal end portion 110 of the catheter body 106 to place opposing severed tissue of the bladder neck into contact with a severed tissue surface of the urethral stump, or vice versa, and preferably also to hold the tissues in contact with each other during the healing period.
Referring to
In related embodiments of devices according to
In various embodiments, as shown in
The drainage feature 160 can be inserted in a compressed state 170 shown in
In various embodiments, as depicted in
As shown in
The catheter and its componentry may be made of materials normally used and known to be useful for such devices, including relatively inert and biocompatible materials. For example, a catheter body may be prepared from a flexible plastic or polymeric material. Examples of materials that may be useful for a catheter body can include silicones, latex, rubbers, polyurethanes, and combinations of these or other materials. A tissue approximating structure can be made from these or other materials, including relatively rigid plastics, polymers, or metals, optionally including bioresorbable materials such as bioresorbable polymers. Examples of metals include stainless steel, nitinol, titanium, tantalum, as well as alloys or combinations of these materials.
In general, a catheter can be used during urethral anastomosis procedures such as that associated with a radical prostatectomy, e.g., vesico-urethral anastomosis, with the catheter functioning to remove urine from the bladder after the procedure. The anastomosis device can be used by inserting the elongate flexible catheter body through the urethra and into the bladder. A portion of the distal end of the device becomes located inside of the bladder where the balloon can be inflated and where the drainage lumen can be used to drain the bladder and keep urine out of the bladder during and subsequent to the procedure. The bladder can preferably be drained of urine during the procedure and during the healing period following the procedure, because urine is preferably kept away from the site of anastomosis to facilitate healing, and also to prevent urine from creating pressure within the bladder.
Certain embodiments can include various drugs and/or cellular mixtures, e.g., cells and adipose tissue, coated onto, or impregnated or otherwise provided with structures of the device. Again, these structures can come into contact with target tissue to increase the speed and degree of healing, and to promote overall tissue health. For instance, the tines or distal tip, with or without fluid injection capabilities, can include the cellular mixtures. In other embodiments, foam wrappings, protrusions, or surface portions of the device can include the drugs and/or cellular mixtures.
Generally, a method of the invention can include a step of performing a radical prostatectomy, such as by a retropubic technique, a laparoscopic technique, or a transperineal technique. These techniques leave a bladder neck and a urethral stump for re-attachment. The distal portion of the anastomosis device may optionally be partially installed during the prostatectomy procedure, e.g., up to the perineal floor, or may be installed to that point afterward. Following removal of the prostate, the catheter body of the distal end of the device is passed through the urethral stump and then through the bladder neck. From there, the technique can include inflating the balloon inside of the bladder, using tissue approximating structure (including tines 54, 46) to place the severed tissue surfaces of the urethral stump and the bladder neck into contact, and injecting drugs or cells (such as a cell mixture) into the target tissue through the engaged injection tines.
All patents, patent applications, and publications cited herein are hereby incorporated by reference in their entirety as if individually incorporated, and include those references incorporated within the identified patents, patent applications and publications.
Although specific examples have been illustrated and described herein, it will be appreciated by those of ordinary skill in the art that any arrangement calculated to achieve the same purpose could be substituted for the specific examples shown. This application is intended to cover adaptations or variations of the present subject matter. Therefore, it is intended that the invention be defined by the attached claims and their legal equivalents, as well as the following illustrative embodiments.
Claims
1. An anastomosis device, comprising:
- a catheter body including a distal treatment end and a proximal biasing end, the catheter body including a drainage lumen fluidly extending between the distal treatment end and the proximal biasing end; and
- a drainage feature mounted at the distal treatment end, the drainage feature including a drainage body having an attachment tip for bonding the drainage body to the distal treatment end and a guide tip, the drainage body adapted so as to assume a first solid orientation during insertion of the distal treatment end to a desired treatment location and to selectively assume a second expanded orientation during a period of tissue retention.
2. The anastomosis device of claim 1, wherein the attachment tip and the guide tip comprise a molded silicone.
3. The anastomosis device of claim 1, wherein the second expanded orientation comprises an elongated orientation.
4. The anastomosis device of claim 1, wherein the second expanded orientation comprises an outwardly bulged orientation.
5. The anastomosis device of claim 1, wherein the catheter body further comprises a tissue approximation structure including a deployment member and a plurality of tines, said plurality of tines being outwardly deployable when actuation by the deployment member.
6. The anastomosis device of claim 5, wherein the deployment member is operably coupled to the drainage body such that the actuation member selectively causes the drainage body to transition between the first solid orientation and the second expanded orientation.
7. The anastomosis device of claim 6, wherein the tissue approximation structure further comprises an inflation balloon, said inflation balloon being fluidly attached to an inflation lumen within the catheter body.
8. The anastomosis device of claim 7, wherein the inflation balloon is mounted on the catheter body between the plurality of tines and the distal treatment end, the inflation balloon including a proximal base portion facing the plurality of tines, wherein the proximal base portion has a wall thickness greater than a distalmost portion of the inflation balloon.
9. The anastomosis device of claim 1, further comprising:
- a removable drain tube, the removable drain tube having a tube length defined between a distal insertion portion and a proximal manipulation portion wherein the distal insertion portion is slidably insertable into the drain lumen.
10. A method for limiting effects of clotting during an anastomosis procedure, comprising:
- providing an anastomosis device including a catheter body having a distal treatment end, a proximal biasing end and a drainage lumen fluidly extending between the distal treatment end and the proximal biasing end;
- attaching a drainage body to the distal treatment end;
- advancing the distal treatment end to a desired treatment location, wherein the drainage body is arranged in a first solid orientation during insertion; and
- adjusting the drainage body to assume a second expanded orientation during a period of tissue retention.
11. The method of claim 10, wherein adjusting the drainage body to assume the second expanded orientation, comprises:
- adjusting the drainage body to assume an elongated orientation.
12. The method of claim 10, wherein adjusting the drainage body to assume the second expanded orientation, comprises:
- adjusting the drainage body to assume an outwardly bulged orientation.
13. The method of claim 10, wherein attaching the drainage body to the distal treatment end, comprises:
- molding an attachment tip of the drainage body to the distal treatment end.
14. The method of claim 10, further comprising:
- actuating an approximation structure on the catheter body to capture and retain tissue during the period of tissue retention.
15. The method of claim 14, wherein the approximation structure comprises a plurality of tines retained within the catheter body, the plurality of tines operably coupled to a deployment member, wherein the step of actuating the approximation member, further comprises:
- biasing the deployment member such that the plurality of tines are directed outwardly from the catheter body.
16. The method of claim 15, wherein biasing the deployment member causes the drainage body to adjust from the first solid orientation to the second expanded orientation.
17. The method of claim 10, further comprising:
- inserting a removable drain tube into the drain lumen;
- removing the removable drain tube during period of tissue retention when flow is disrupted through the removable drain tube; and
- inserting a second removable drain tube into the drain lumen.
Type: Application
Filed: Dec 15, 2011
Publication Date: Jun 21, 2012
Inventors: Christopher Anderson (New Hope, MN), Patricia M. Derus (Rogers, MN)
Application Number: 13/326,936
International Classification: A61B 17/11 (20060101);